Claims

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Documents

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Frequently used forms

Accidental dental claim form

Dental claim form

Health Spending Account (HSA) claim form

Health benefits claim form (includes vision)

Specialty claim forms

Ambulance/Medical Transfer Claim Form

Assisted care nursing recommendation claim form

Glucose monitoring special authorization request form

Hospital claim form

Orthotics, orthopedic shoes and modifications claim form

Pre-authorization request form

Bank forms

Direct deposit application form

Travel forms

Submit to CanAssistance, Manitoba Blue Cross’s emergency travel assistance provider

Baggage Benefit claim form

Travel Insurance claim form

Trip Cancellation Insurance claim form